Interventions for Ventilator Associated Pneumonia

Interventions for breathing apparatus Associated PneumoniaVentilator associated pneumonia is defined as pneumonia developing in persons who have received mechanic ventilation for at least 48 hours (Shi et al., 2010). It is a major terror to critically ill patients receiving mechanical ventilation (Feider, Mitchell, Bridges, 2010) and it is the most common torsion of patients in Intensive C atomic number 18 Units (Soh et al., 2011). Nosocomial pneumonia is ca utilize by bacteria that annex within the oral cavity of patients in the intensive care units (Ewig et al., 1998). Bad oral health is pivotal in the pathogenesis of this harmful complication (Blot, Vandijck Labeau, 2008). Thus, good oral hygiene measure has a critical role in preventing the spread of these bacteria from the oral cavity to the lower respiratory tract thereby trim the chances of nosocomial pneumonia (McNeill, 2000 cited in Abidia, 2007).There ar a couple of interventions which are recommended to prevent Ventilator Associated Pneumonia. The Institute of Health cover Improvement suggested the VAP bundle of interventions in preventing Ventilator Associated Pneumonia. (Fields, 2008) In addition to these interventions, oral hygiene care is a nursing intervention that may also help prevent ventilator-associated pneumonia (Feider, Mitchell Bridges, 2010). take the stand shows that comprehensive oral care is an powerive preventive strategy to subvert the risk of ventilator-associated pneumonia in patients receiving mechanical ventilation (Cutler Davis, 2005). There are a lot of interrogation studies fundinging oral hygiene care in reducing VAP cases among mechanically vent patients. In the education of Mori et al., (2006), the incidence of VAP was significantly lower in patients who received oral care than the patients who did not. Similarly, Fields (2008) study showed that VAP rate dropped to zero within a week of beginning the any hours tooth brushing regimen in the interventi on stem. Another study shows that pneumonia, feverish days, and death from pneumonia decreased significantly in patients with oral care (Yoneyama et al., 2002). miscellaneous methods and equipment in providing oral care for intubated patients were also studied. Toothbrushes and topical antimicrobials (Binkley, Furr, Carrico McCurren, 2004 Grap, Munro, Ashtiani Bryant, 2003), oral decontamination (Bergmans et al., 2001) and oropharyngeal decontamination with 0.12% Chlorhexidine Gluconate oral rinse (Shi et al., 2010 Tantipong, Morkchareonpong, Jaiyindee Thamlikitkul, 2008 Koeman et al., 2006 Houston et al., 2002 Genuit, Bochicchio, Napolitano, McCarter Roghman, 2001 DeRiso, Ladowski, Dillon, Justice Peterson, 1996) were found to be effective in reducing the bacteria in the mouth and in reducing the incidence of VAP.The AACN (2010) came up with a comprehensive oral hygiene program for patients in critical care and acute care settings who are at lavishly risk for ventilator-as sociated pneumonia. This includes brushing teeth, gums and tongue at least twice a day utilise a soft pediatric or bighearted toothbrush providing oral moisturizing to oral mucosa and lips every 2 to 4 hours and using an oral chlorhexidine gluconate (0.12%) rinse twice a day during the perioperative hitch for adult patients who undergo cardiac surgery. The routine use of oral chlorhexidine gluconate (0.12%) in other populations is not recommended at this time. These interventions are supported by the alert evidence of oral hygiene.Past research studies have focused on assessing the oral care knowledge, attitude and dedicates among ICU nurses. Studies had shown that ICU nurses lack fitted knowledge on oral care (Jordan, Badovinac, palj, Par, laj Planak, 2014 Chan Hui-Ling Ng, 2012). The methods used to suffer oral care were also found to be varied surrounded by nurses in the same unit (Soh et al., 2011 Chan Hui-Ling Ng, 2012). Moreover, the oral care currently provided in ICUs may be ineffective in eradicating dental plaque and respiratory pathogens that may cause VAP to ventilated patients (Binkley, Furr, Carrico, McCurren, 2004). There was also existing discrepancies among reported practices and policies on oral care provided to intubated patients (Feider, Mitchell Bridges, 2010). Though oral care is perceived to be high priority in mechanically ventilated patients, difficulties, problems and barriers still exist in providing the care (Rello et al., 2007 Feider, Mitchell Bridges, 2010 Soh, Soh, Japar, Raman Davidson, 2011). These challenges include mechanical barriers and equipment issues, knowledge on the importance of oral care and empathy to patients discomfort by nurses, altered patient sensory knowledge and discomfort, and communication problems. (Berry Davidson, 2006) The existence of variation in oral care practices, the ineffective provision of oral care and the lack of sufficient knowledge of ICU nurses warrants a standardized pr otocol or guidepost that is based on existing evidence. (Soh et al., 2011 Lin, Chang, Chang Lou, 2011)In the past years, licence ground Practice (EBP) is gaining its momentum in the healthcare sector. It has been the focus of discussions and research in the medical field. Its importance to the medical practice has been evident and olibanum encouraged to be integrated in the practice. However, translating evidence into clinical practice remains a big challenge at the moment. Significant gaps between what is known to improve health, and what is done to improve health is evident (Holmes, Scarrow Schellenberg, 2012). These gaps possibly caused by unawareness or unfamiliarity of clinicians to EBP guidelines or recommendations or the clinicians distrust towards the EBP recommendations or the clinicians personal opinion on the recommended management or the clinicians perception that the guideline is too complicated or difficult to use in their own practices patient-related factors and the mentality that altering established practice is often difficult. (Pierson, 2009) examine based guidelines for providing oral care to patients in mechanical ventilators were formulated by international organizations, but, not all intensive care unit nurses are knowledgeable about it. Past study indicated that nurses lacked the evidence-based knowledge to deliver right care (Chan, Lee, Poh, Ng Prabhakaran, 2011). In addition, a study also showed that ICU nurses did not follow procedures and steps recommended by current evidence-based practice (Lin, Chang, Chang Lou, 2009). divers(a) knowledge description strategies such as opinion leaders, audits and feedback, small group consensus, provider varan systems, incentives, clinical information systems, and computer finality support systems can be utilized to integrate EBP into the clinical world. These knowledge translation strategies should be attempted and researched in clinical setting and should be used to further imp rove clinical practice. (Ganz et al, 2013)Therefore, the focus of this current research is to read knowledge of Evidence based oral care practice guideline for mechanically ventilated adult ICU patients to clinical practice using a provider monitor lizard system strategy. Further, it will determine the effect of the provider reminded system strategy in improving the Evidence Based oral care practices for mechanically ventilated patients among ICU nurses. Provider reminder system is one of the Quality Improvement (QI) strategies. Example of provider reminder system includes reminders in charts for providers, computer based reminders for providers, and computer based decision support. (Hughes Hughes, 2008)